1437330339 NPI number — AEGIS PHYSICAL THERAPY INC. PS

Table of content: (NPI 1437330339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437330339 NPI number — AEGIS PHYSICAL THERAPY INC. PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AEGIS PHYSICAL THERAPY INC. PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437330339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2721
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98907-2721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-895-7449
Provider Business Mailing Address Fax Number:
509-895-7452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 KERN WAY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-895-7449
Provider Business Practice Location Address Fax Number:
509-895-7452
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALLOWAY
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
MERLIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-895-7449

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT00010836 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com